health & science

Rising cost of failure to digitise healthcare system

New Zealand is missing out on hundreds of millions of dollars as it continues to drag its feet on health system digitisation, Laura Walters reports

A former director general of health and public sector consultant says the cost of New Zealand not digitising its health system is more than $300 million, thanks to variations in performance and the safety risks that come with a lack of access to real-time, quality data.

EY government and public sector lead Stephen McKernan said New Zealand’s failure to rollout digitisation of records and information across the health system was a lost opportunity.

Currently, there are pockets of innovation, but that was not being shared with the whole system, which meant inequitable access and outcomes, he said.

Rolling out digital innovations across the system would mean better access to data for planning and decision-making, and also mean clinicians had access to important real-time information including things like diagnoses, medications and allergies and could provide better and safer care.

While many patients assumed their data was held in a secure and accessible system, meaning the emergency department could pull up patients' records and information from GPs, for example, this wasn’t always the case.

There are many current barriers to having patients, healthcare providers, clinicians, researchers and policy makers input, access and utilise consumer data, but all could be overcome, McKernan said. Other countries of a similar size to New Zealand, such as Denmark and smaller countries like Estonia, which use blockchain technology, have successfully digitised their healthcare systems and records.

McKernan said the lack of access to digitised data resulted in variations in performance across the healthcare system, which had a real cost.

The average cost of each hospital admission is $5000, with patients staying in hospital for an average of 3.5 days.

Based on studies done in the United States, variations of performance in New Zealand would be costing “well north” of $300 million a year.

“We’ve tried to aim; we’ve continued to aim and aim and aim, without firing."

McKernan said consumers wanted the change, "but it feels like it’s the system not responding".

New Zealand has been talking about joining up the country’s health data for nearly 10 years, starting with the National Health IT plan in 2010. Then there was the Single National Electronic Health Record floated in 2015, the national Health Information Platform indicative business case landed in 2017, and in September Cabinet signed off on the high-level business case for the health information platform.

A total of $1.8 million in funds were allocated for the business case phase and interim Digital Investment Board met for the first time in October. The business case is due to be completed before the end of the year.

While there has been a lot of talk about a move to digitising health data, and there is now a good vision to go with it, work had stalled for a long time because it wasn’t made a priority.

“We’ve tried to aim; we’ve continued to aim and aim and aim, without firing," McKernan said.

He is now calling on the Government to make it a priority and put in place a clear and immediate implementation plan.

Barriers to digitisation

The Health and Disability System Review interim report, released in August, speaks extensively about the current gaps in gathering, collating, sharing and accessing patient data.

The lack of integration between providers means patients have to repeatedly give the same information, which is “frustrating, burdensome, and, in some cases, increases risk and results in poorer health outcomes for consumers”, the report says.

There are some practical limitations, like patient information being in PDF format, meaning it wasn’t machine-readable, and was therefore difficult to access and use in clinical settings and for wider reporting or research. Then there is the burden of manual input, and the high risk of human error that comes with that.

There are issues of so-called ‘shadow IT’, where clinicians having issues with IT systems develop their own systems or use other software to record data. In the past, using programmes on computers, like excel, has created information islands.

EY's Stephen McKernan says the risk of a data breach isn't an excuse not to upgrade systems and rollout digitisation across the system. Photo: Supplied

During the review’s consultation, privacy was cited as the main reason for providers not sharing data.

However, privacy laws and limitations are often misunderstood.

Experts who submitted to the review said the privacy barrier was more perceived than real. The law allowed for non-identifying data to be shared and used openly, and identifying data could be shared either with consent or under appropriate circumstances.

New Zealand’s failure to launch could also be attributed to people’s – namely policymakers’ – risk tolerance, McKernan said.

There was the potential for data breaches, and the stakes were high when it came to sensitive health information.

This was borne out earlier in the year with the hack of Tū Ora Compass Health – the primary health organisation for Wellington Kāpiti and Wairarapa.

The cyber-attack meant up to 1 million patients, who were enrolled with one of the PHO’s medical centres between 2002 and 2019, could have been affected.

“What we can’t have is another decade where we lose traction. Technology is moving rapidly, we need to revisit how the system functions, and how decisions are made."

But McKernan said these types of risks should not be a reason not to push ahead with a digitisation strategy.

“There is risk and impact happening right now. And we need to perhaps highlight that as part of the case for change.

If the current system faced criticism, and people understood the risks and impacts, they would be more likely to embark on a different trajectory.

New digital infrastructure, and greater system-level infrastructure, would be better and more secure than trying to maintain a plethora of historical systems that required regular updates and were more susceptible to something going wrong, he said.

The Ministry of health hopes its business case will be finalised before the end of the year, along with proof of concepts to test the technology and a full cost benefit analysis of what's needed to deliver on the vision of a national health information platform. Photo: Lynn Grieveson

“What we can’t have is another decade where we lose traction. Technology is moving rapidly, we need to revisit how the system functions, and how decisions are made.

“We see oodles of innovation happening, and that’s fantastic. But what we don’t see is that being rolled out so that everyone benefits.”

Ministry of Health digital strategy and investment group manager Darren Douglass said the national health information platform would transform access to and use of health information, improving the wellbeing of New Zealanders.

It was designed to give consumers, health care providers and planners access to health information across sector systems.

“It is the starting point along a pathway toward a better connected, safer, more reliable digital health environment,” Douglass said.

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